Paolo Colonna

Assessment of QT dispersion in symptomatic patients with congenital long QT syndromes

It has been suggested that QT dispersion recorded on the surface electrocardiogram may be a predictor of arrhythmic events in patients with congenital QT prolongation. To evaluate this, 9 patients (6 female, mean age 17.6 years) with congenital long QT syndromes, all of whom had syncope and documented torsades de pointes, were studied. Patients were studied off treatment and during therapy with beta-blocking agents. Three patients were also studied after left stellate ganglionectomy. An age-matched control group was also studied. Good quality 12-lead electrocardiograms were recorded from all patients. For each lead, QT and RR intervals were measured, and QTc value was calculated. QT and QTc dispersions were calculated for each patient. Patients had a significantly longer mean QT interval compared with that of the control group (450 +/- 100 vs 359 +/- 63 ms; p = 0.015) at similar mean RR intervals (736 +/- 231 vs 783 +/- 289 ms), with a longer mean QTc value (0.53 +/- 0.08 vs 0.41 +/- 0.02 s1/2; p = 0.004). Patients also had longer QT and QTc dispersions compared with those of the control group (110 +/- 45 vs 43 +/- 12 ms [p = 0.004], and 0.108 +/- 0.03 vs 0.05 +/- 0.02 s1/2 [p = 0.002], respectively). QT and QTc dispersions on and off beta-blocking agents were not significantly different. Comparing patients with frequent and those with infrequent symptoms, there was no difference in QT or QTc dispersion either off treatment or during therapy with beta-blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonpharmacologic Care of Heart Failure: Counseling, Dietary Restriction, Rehabilitation, Treatment of Sleep Apnea, and Ultrafiltration

The prognosis of patients with chronic congestive heart failure (CHF) depends not only on pharmacologic therapy but also on nonpharmacologic aspects. A complete and ongoing education program for treating CHF includes an understanding of the causes of CHF, symptoms, diet, salt and fluid restriction, drug regimen, compliance, physical and work activities, lifestyle changes, and measures of self-control. Moreover, the nonpharmacologic treatment (dietary modifications, lifestyle, physical exercise, and health care education) must be inserted in a multidisciplinary program organized by the physician in conjunction with the health system, the nurses, and, especially, the patients themselves, who must understand their disease and the many therapeutic options. Cardiologists should treat patients in a clear and comprehensible way, and other specialists (dietitians, physiotherapists, psychologists, nurses, and social workers), together with the patients family, should strive for the best living conditions for the patient. In this way, the treatment of CHF can improve the quantity and quality of life and save a significant amount in health care costs.

Guías de práctica clínica para el manejo de la fibrilación auricular

Responsabilidad: Las Guias de Practica Clinica recogen la opinion de la ESC y se han elaborado tras una consideracion minuciosa de las evidencias disponibles en el momento en que fueron escritas. Se anima a los profesionales de la sanidad a que las tengan en plena consideracion cuando ejerzan su juicio clinico. No obstante, las Guias de Practica Clinica no deben invalidar la responsabilidad individual de los profesionales de la salud a la hora de tomar decisiones adecuadas a las circunstancias individuales de cada paciente, consultando con el propio paciente y, cuando sea necesario y pertinente, con su tutor o representante legal. Tambien es responsabilidad del profesional de la salud verificar las normas y los reglamentos que se aplican a los farmacos o dispositivos en el momento de la prescripcion. El contenido de las Guias de Practica Clinica de la Sociedad Europea de Cardiologia (ESC) ha sido publicado para uso exclusivamente personal y educacional. No esta autorizado su uso comercial. No se autoriza la traduccion o reproduccion en ningun formato de las Guias de la ESC ni de ninguna de sus partes sin un permiso escrito de la ESC. El permiso puede obtenerse enviando una solicitud por escrito a Oxford University Press, la empresa editorial de European Heart Journal y representante autorizada de la ESC para gestionar estos permisos.

Tako-Tsubo syndrome in a pregnant woman

We describe a rare case of Tako-Tsubo syndrome which occurred in a young woman at the beginning of pregnancy, who presented cardiac arrest at onset. In this case, the transient left ventricular ballooning involving both mid and apical segments, in absence of coronary artery disease, produced a severe impairment of cardiac function with typical echocardiographic and electrocardiographic findings. The favourable outcome, despite the sudden cardiac death at the beginning, raises further questions on this new kind of cardiomyopathy.

Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure.

Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13xa0years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction <50%) and 483 diastolic dysfunction. According to the CRC, 891 patients were normals or presented with physiologic hypertrophy, 273 concentric remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29xa0mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p <0.001). After a median follow-up of 21xa0months, Kaplan-Meier analysis showed different survival distribution (p <0.001) of the CRC patterns. In multivariate Cox regression (adjusted for age, gender, history of stable ischemic heart disease, classic remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (pxa0= 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.

In search of the best prognostic factor in patients with congestive heart failure: the paradox of ejection fraction without prognostic significance.

Introduction Nowadays, thanks to the improvement in cardiac heart failure (CHF) therapy and the use of implantable cardioverter defibrillators (ICDs), the life expectancy of patients with ischemic cardiomyopathy is much longer than in the past and the risk of acute or recurrent decompensated heart failure has been reduced. However, since cardiac mortality is still high, it is a mandatory task to identify patients at higher morbidity and mortality among CHF patients already treated with ICD [1].

Edoxaban in Atrial Fibrillation and Venous Thromboembolism—Ten Key Questions and Answers: A Practical Guide

Edoxaban is the fourth non-vitamin K antagonist oral anticoagulant now available for clinical use in the prevention of stroke/systemic embolism in atrial fibrillation (AF) and in the treatment of venous thromboembolism (VTE), after the completion of large-scale randomized comparative clinical trials with the vitamin K antagonist warfarin. Edoxaban has some peculiar pharmacological properties and outcome data. Here a group of experts in AF and VTE answers a set of questions on its practical use, trying to define the profile of patients that would be most appropriate for its use.

482 Coronary recanalization evaluation after acute myocardial infarction: comparison between continuous EKG ST monitoring (MIDA) versus contrast echocardiography for perfusion and coronary flow detection

Background: After acute myocardial infarction (AMI), the persistent elevation of ST segment in the surface electrocardiogram (EKG) predicts lack of coronary recanalization and bad prognosis. In these patients the reperfusion may remain impaired due to the occlusion of the epicardial coronary vessel, or to a process of microvascular injury, detectable with intravenous myocardial contrast echocardiography. We hypothesized that patients with a rapid ST segment return to baseline have a better myocardial contrast perfusion and coronary artery patency. Methods: In 18 patients with a first AMI (15 treated with intravenous thrombolysis), a surface EKG with continuous ST monitoring (MIDA) was recorded for 24 hours after admission; the ST elevation was summed in all anterior leads and the percentage of recovery of the summation at 90 minutes ECG was computed. Intravenous myocardial contrast echocardiography (Sonovue) with harmonic power Doppler (Agilent Sonos 5500) was performed 2.8±0.9 days after the acute phase and the coronary flow in the anterior descending coronary artery was investigated in the 8 patients with anterior AMI. Results: In 11/18 patients (61.1%) ST segment resolution was >50% of the baseline value, and in 9 of these 11 patients (81.8%) there was optimal perfusion at contrast echocardiography. Among the 7 with persistent ST elevation only 2 patients (28.6%, p<0.05) showed a good perfusion. In 5 of the 8 anterior AMI patients the color Doppler flow was visualized in the anterior descending coronary artery, and all 5 showed a ST recovery and normal perfusion. Conclusion: After AMI the myocardial perfusion at contrast echocardiography and the coronary color Doppler flow are related to the ST segment resolution at continuous ST monitoring (MIDA), indicative of coronary artery recanalization.